Endoscopic Gluteus Medius and Minimus Repair With Allograft Augmentation Using Acellular Human Dermis  Jovan Laskovski, M.D., Ryan Urchek, M.D.  Arthroscopy Techniques  Volume 7, Issue 3, Pages e225-e230 (March 2018) DOI: 10.1016/j.eats.2017.08.073 Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 1 Fluoroscopic guidance with needle localization of distal anterolateral (DALA) and proximal anterolateral (PALA) portals. The patient is in the supine position. Arthroscopy Techniques 2018 7, e225-e230DOI: (10.1016/j.eats.2017.08.073) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 2 Probe palpating soft spot localizing the partial gluteus medius and minimus tear. The picture is labeled for orientation in the supine position. Arthroscopy Techniques 2018 7, e225-e230DOI: (10.1016/j.eats.2017.08.073) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 3 After completion of the partial gluteus medius tear, multiple 2.8-mm anchors are placed with sutures passed in a horizontal mattress fashion and tied after all sutures are passed as necessary. Arthroscopy Techniques 2018 7, e225-e230DOI: (10.1016/j.eats.2017.08.073) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 4 After repair of the tendon, fluoroscopic guidance and a calibrated probe with 5-mm markings are used to measure the length and width of the footprint to help size the graft required. Arthroscopy Techniques 2018 7, e225-e230DOI: (10.1016/j.eats.2017.08.073) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 5 Placement of a 1.3-mm percutaneous anchor, single loaded, under fluoroscopic guidance. Arthroscopy Techniques 2018 7, e225-e230DOI: (10.1016/j.eats.2017.08.073) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 6 The graft is marked to help with the orientation of the graft during placement. The epidermal side of the graft should face superficial during fixation. An antegrade suture passer device is used to pass the suture from deep to superficial, and a grasper is used to retrieve the suture. A mulberry knot is then tied so it lies on the superficial (epidermal) surface of the graft. Arthroscopy Techniques 2018 7, e225-e230DOI: (10.1016/j.eats.2017.08.073) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 7 The graft is then oriented appropriately to the cannula with the anterosuperior and posterosuperior mulberry knots previously placed. Arthroscopy Techniques 2018 7, e225-e230DOI: (10.1016/j.eats.2017.08.073) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 8 The graft is then folded longitudinally to ease delivery, and the opposite limbs of the previously placed anchors are used to shuttle the graft to the footprint. Arthroscopy Techniques 2018 7, e225-e230DOI: (10.1016/j.eats.2017.08.073) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 9 Fluoroscopic guided placement of the anteroinferior and posteroinferior 1.3-mm percutaneous anchors. Arthroscopy Techniques 2018 7, e225-e230DOI: (10.1016/j.eats.2017.08.073) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions

Fig 10 The final graft fixation with 6 knots tied compressing the graft to the footprint. Arthroscopy Techniques 2018 7, e225-e230DOI: (10.1016/j.eats.2017.08.073) Copyright © 2017 Arthroscopy Association of North America Terms and Conditions